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These symptoms were reported in 10 to 40 percent of both vaccine and placebo recipients. LAIV not licensed for children &lt;60 months of age.

Influenza8p

1.
<ul><li>Influenza and Influenza Vaccine </li></ul>Epidemiology and Prevention of Vaccine-Preventable Diseases National Immunization Program Centers for Disease Control and Prevention Revised December 2004

2.
Note to presenters: Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at http://www.vaccineinformation.org/photos/index.asp

7.
Influenza Antigenic Changes <ul><li>Hemagglutinin and neuraminidase antigens change with time </li></ul><ul><li>Changes occur as a result of point mutations in the virus gene, or due to exchange of a gene segment with another subtype of influenza virus </li></ul><ul><li>Impact of antigenic changes depend on extent of change (more change usually means larger impact) </li></ul>

15.
Impact of Influenza <ul><li>~36,000 excess deaths per year </li></ul><ul><li>>90% of deaths among persons > 65 years of age </li></ul><ul><li>Higher mortality during seasons when influenza type A (H3N2) viruses predominate </li></ul>

16.
Impact of Influenza <ul><li>Highest rates of complications and hospitalization among young children and person > 65 years </li></ul><ul><li>Average of >200,000 influenza-related excess hospitalizations per year since 1969 </li></ul><ul><li>57% of all hospitalizations among persons <65 years of age </li></ul><ul><li>Greater number of hospitalizations during type A (H3N2) epidemics </li></ul>

19.
Influenza Epidemiology <ul><li>Reservoir Human, animals (type A only) </li></ul><ul><li>Transmission Respiratory Probably airborne </li></ul><ul><li>Temporal pattern Peak December – March in temperate area May occur earlier or later </li></ul><ul><li>Communicability Maximum 1-2 days before to 4-5 days after onset </li></ul>

22.
Composition of the 2004-2005 Influenza Vaccine* <ul><li>A/Fujian/411/2002 (H3N2) </li></ul><ul><li>(A/Wyoming/3/2003) </li></ul><ul><li>A/New Caledonia/20/99 (H1N1) </li></ul><ul><li>B/Shanghai/361/2002 </li></ul><ul><li>(B/Jilin/20/2003 or B/Jiangsu/10/2003) </li></ul>*strains in (parenthesis) are antigenically identical to the selected strains and may be used in the vaccines

25.
LAIV Efficacy in Healthy Children <ul><li>87% effective against culture-confirmed influenza in children 5-7 years old </li></ul><ul><li>27% reduction in febrile otitis media (OM) </li></ul><ul><li>28% reduction in OM with accompanying antibiotic use </li></ul><ul><li>Decreased fever and OM in vaccine recipients who developed influenza </li></ul>

27.
Timing of Inactivated Influenza Vaccine Programs <ul><li>Actively target vaccine available in September and October to persons at increase risk of influenza complications, children <9 years, and healthcare workers </li></ul><ul><li>Vaccination of all other groups should begin in November </li></ul><ul><li>Continue vaccinating through December and later, as long as vaccine is available </li></ul>

34.
Influenza Vaccine Recommendations <ul><li>Healthcare providers, including home care (TIV only) </li></ul><ul><li>Employees of long-term care facilities (TIV only) </li></ul><ul><li>Household members of high-risk persons including children 0-23 months (TIV or LAIV*) </li></ul>*household and other close contacts of immuno- suppressed persons should not receive LAIV

35.
Influenza Vaccine Recommendations* <ul><li>Providers of essential community services </li></ul><ul><li>Foreign travelers </li></ul><ul><li>Students </li></ul><ul><li>Anyone who wishes to reduce the likelihood of becoming ill from influenza </li></ul>*these groups may receive TIV, and some may be eligible for LAIV

36.
Influenza Vaccination of Children <ul><li>Children <24 months at increased risk of hospitalization </li></ul><ul><li>Inactivated influenza vaccination of healthy children 6-23 months is recommended </li></ul><ul><li>Vaccination of household contacts and out-of-home caretakers is encouraged </li></ul>

37.
In the 2001 National Health Interview Survey, only 36% of healthcare workers reported receiving influenza vaccine in the previous 12 months.

38.
Influenza Vaccination of HCWs <ul><li>Educate HCWs about the benefits of vaccination for themselves, their families, and their patients </li></ul><ul><li>Educate staff about vaccine adverse reactions </li></ul><ul><li>Provide free vaccine at the work site to all employees, including night and weekend staff </li></ul>

39.
Live Attenuated Influenza Vaccine Dosage, by Age Group, United States <ul><li>Age Group </li></ul><ul><li>5-8 years, no previous influenza vaccine </li></ul><ul><li>5-8 years, previous influenza vaccine * </li></ul><ul><li>9-49 years </li></ul><ul><li>Number of Doses </li></ul><ul><li>2 (separated by 6-10 weeks) </li></ul><ul><li>1 </li></ul><ul><li>1 </li></ul>* LAIV or inactivated vaccine

40.
Live Attenuated Influenza Indications <ul><li>Healthy* persons 5 – 49 years of age </li></ul><ul><ul><li>Close contacts of persons at high risk for complications of influenza (except immunosuppressed) </li></ul></ul><ul><ul><li>Persons who wish to reduce their own risk of influenza </li></ul></ul>*Persons who do not have medical conditions that increase their risk for complications of influenza

41.
Vaccination of Healthcare Workers and Close Contacts of Immunosuppressed Persons <ul><li>No data regarding transmission from adults vaccinated with LAIV to immunosuppressed persons </li></ul><ul><li>ACIP prefers the use of inactivated influenza vaccine for persons with household or other close contact with immunosuppressed persons, including healthcare workers </li></ul>

42.
Simultaneous Administration of LAIV and Other Vaccines <ul><li>Inactivated vaccines can be administered either simultaneously or at any time before or after LAIV </li></ul><ul><li>Other live vaccines can be administered at the same visit as LAIV </li></ul><ul><li>Live vaccines not administered on the same day should be administered >4 weeks apart </li></ul>

48.
LAIV Storage and Handling <ul><li>Must be stored at < +5 ° F (-15 ° C ) at all times </li></ul><ul><li>Do NOT store in a frost-free freezer </li></ul><ul><li>Store ONLY in a MANUAL defrost freezer </li></ul><ul><li>If no manual defrost freezer, must store LAIV in special freezer box supplied by the manufacturer </li></ul>

50.
Influenza Vaccine Missed Opportunities <ul><li>Up to 75% of persons at high risk for influenza or who die from pneumonia and influenza may have received care in a physician's office in the previous year. </li></ul><ul><li>In one study all non-nursing home persons who died from pneumonia or influenza had at least one medical visit in the previous year. </li></ul>

51.
Influenza Antiviral Agents* <ul><li>Amantadine and rimantadine </li></ul><ul><ul><li>effective against influenza A only </li></ul></ul><ul><ul><li>approved for treatment and prophylaxis </li></ul></ul><ul><li>Zanamivir and oseltamivir </li></ul><ul><ul><li>neuraminidase inhibitors </li></ul></ul><ul><ul><li>effective against influenza A and B </li></ul></ul><ul><ul><li>oseltamivir approved for prophylaxis </li></ul></ul>*see influenza ACIP statement for details